Management of a Pediatric Type 3C Open Femoral Fracture Following a High-Velocity Gunshot Wound at an Adult Level II Trauma Center.

ABSTRACT: We present a case of a 10-year-old girl shot in the thigh by a stray bullet who had a favorable outcome when treated with a multidisciplinary approach at the nearest nonpediatric level II trauma center. Point-of-care thromboelastography facilitated effective resuscitation based on her coagulation profile, minimized blood product use, and allowed for damage-control surgery to stabilize and revascularize her complex femur fracture.

Utility of noninvasive aneurysm sac pressure measurement during and after endovascular abdominal aortic aneurysm repair.

PURPOSE: The utility of noninvasive pressure sensors in the intra- and postoperative settings is not entirely clear. The objectives of this study were to determine intraoperative pressure criteria in the setting of technically successful endovascular aneurysm repair (EVAR) and to evaluate pressure changes during follow-up. MATERIALS AND METHODS: A total of 55 patients (42 men) underwent attempted noninvasive sensor monitor placement within the aneurysm sac. Pressures were recorded before and after EVAR. Recordings were repeated at 1 day, 2 weeks, 3 months, and 1 year. Clinical data, pressure recordings, and computed tomography were retrospectively assessed. RESULTS: Noninvasive pressure sensors were successfully placed in 51 patients. The mean intraoperative decreases in pulse pressure (PP) and PP ratio (PPR) in the setting of technical success were statistically different versus (i) baseline recordings and (ii) pressures obtained in the setting of type I endoleak (74.2% vs 41.5% and 76.2% vs 46.5%, respectively). At follow-up, there were continued decreases in PP and PPR, with a decrease in mean pressure resuming at the 3-month interval. Four of 14 type II endoleaks were treated because of relatively increased pressure with stable or increased aneurysm size. CONCLUSIONS: An intraoperative decrease in PP and PPR in the range of approximately 70% after EVAR was associated with successful aneurysm exclusion. Noninvasive sensors can provide useful ancillary information in confirming technical success intraoperatively. During follow-up, an increase in sensor pressure recordings may be suggestive of clinically significant endoleak; however, further research is necessary.